Impaired Risk Review…
Robert Goldstone
January 2019

The call often comes in like this one: “My client does something called vaping.  It’s not like smoking cigarettes—it’s much less toxic.   He doesn’t do it that often.  He can get a non-tobacco policy, right?”  So, what is vaping?   How toxic is it if at all?  And can you get a non-tobacco policy?

Vaping is defined by the Center on Addiction as the act of inhaling and exhaling the aerosol, also referred to as vapor, which is produced by an e-cigarette or similar device.  Vaping devices generally consist of a mouthpiece, a battery, a cartridge containing the liquid which will be aerosolized, and a heating component that is usually battery powered.  The battery heats up the heating coil, which converts the liquid into an aerosol that is inhaled into the lungs just as you would smoke a regular cigarette.  The process in actual cigarette smoking is the same, and the incidence of vaping is quite prevalent—it’s estimated that 1 in 5 high schoolers use e-cigarettes and “vape.”

The idea behind the e-cigarette was to involve a process that was less toxic to the user and cut down on the number of tobacco related deaths in long term smokers.  The liquid that is used in the pod (as it’s also called) is usually a propylene glycol-based fluid that may contain flavoring and chemicals.  However, one of the major components in most of the preparations is still nicotine.  The average pod contains about 40mg of nicotine, very similar to what is contained in traditional cigarettes.  Nicotine addiction can happen just as easily with vaping as it can from usual forms of smoking.

The most popular of the e-cigarettes used in vaping is called the Juul.  It’s a device that looks from a distance just like a USB port.  It can be carried very inconspicuously and is the method of choice in usage by students in school to avoid detection.  It is, however, an entrance to nicotine addiction in the younger population who may not have been drawn to smoking otherwise.  Juul provided cartridges in many different flavors, which also promoted its use.  Traditional cigarette manufactures have been looking to buy into the Juul corporation as a hedge against decreased popularity of cigarettes.  

Are e-cigarettes void of any risk besides flavoring and nicotine?   Many pods contain other carcinogens such as formaldehyde and others may include marijuana.  Nicotine is certainly addictive and increased heart rate and blood pressure are known side effects.  While e-cigarette vapor is less harmful than tobacco smoke, it is not innocuous.  Cough, increased airway difficulties, nausea and vomiting are reported effects of vaping, and of course any other chemicals that are added to the pod have their own set of side effects.  

Insurers have problems with handling vaping at the present time.  The research on vaping and its long-term side effects is in its infancy.  Because vaping products contain nicotine, screening tests that insurers use to detect smokers will always be positive.  Some “vapers” are also smokers which makes mortality difficult to separate.  The conversion of those using e-cigarettes to traditional tobacco products is unknown.  Custom made pods can contain any variety of chemicals with unknown effects on the lungs and the body.

Insurers’ position on vaping is not consistent at this time.  Some feel that while it may be better than tobacco smoking, it does have more effects on mortality than not smoking at all—so vaping is priced as smoking.  Some insurers will price any policy where tobacco is found in the urine sample as a smoker, regardless of how the nicotine was ingested.  And some price the vaping population as non-smokers.  There are a lot of variables to consider and a lot of research that has to be done on the potential health effects of vaping and, until then, expect a changing landscape with how e-cigarettes and vaping will be treated.

Author's Bio
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and An­nu­ity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endo­­­crinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by ­telephone at 949-943-2310. Emaill: [email protected]

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